Provider Demographics
NPI:1265685788
Name:RIVERS, DEBORAH HANSARD (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:HANSARD
Last Name:RIVERS
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 PINE KNOTT RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-3230
Mailing Address - Country:US
Mailing Address - Phone:770-306-2784
Mailing Address - Fax:770-306-2784
Practice Address - Street 1:130 PINE KNOTT RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-3230
Practice Address - Country:US
Practice Address - Phone:770-306-2784
Practice Address - Fax:770-306-2784
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006389235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist